Ligaments are frequently damaged (e.g., detached, torn or ruptured) as the result of injury or accident. A damaged ligament can impede proper stability and motion of a joint and cause significant pain. When ligaments are damaged, surgical reconstruction can be necessary, as the ligaments may not regenerate on their own.
A damaged ligament can be replaced or repaired using various procedures, the choice of which can depend on the particular ligament to be restored and the extent of the damage. A common ligament reconstruction procedure involves using an autograft, which is a portion of the patient's own tendon that would replace the damaged natural ligament. The autograft is often a hamstring tendon, though other tendons, such as a patellar tendon, can be used. The ligament graft can also be obtained from a donor, known as an “allograft.” Ligament reconstruction procedures typically require preparation of the ligament graft to secure the graft for passing through the repair site and to strengthen the graft prior to fixation. This preparation may involve cleaning and measuring the graft, and then affixing sutures to free ends of the graft to reinforce it. The reinforcement is intended to maintain the structural integrity of the graft and to allow the graft to be properly tensioned when it is inserted into the repair site, such as a tunnel in bone. Sutures are typically affixed to the graft so that free ends of the suture extend from one or both ends of the graft. These free ends are used to secure the graft, either directly or indirectly.
For ligament reconstruction techniques such as Anterior Cruciate Ligament (ACL) and biceps tenodesis procedures, whip-stitching is frequently used for affixing the sutures to the graft. Traditionally, whip-stitching is performed with a single suture and needle, making three to five up-throws and an equal number of down throws, and piercing through the tissue in a staggered fashion while the tissue is held at one end by a tissue clamp. Alternatively, whip-stitching can be performed with a looped suture and needle by placing the tissue through the suture loop, piercing through the tissue, and repeating the steps as described above. However, placing the tissue through the suture loop often requires passing the tissue clamp through the suture loop as well, adding time and difficulty to the surgical procedure.